Is Acetaminophen Safe To Take When You’re Drinking?

The dance floor’s hopping, the drinks are flowing and the bass is pounding. Or is that just your head?

Headaches aren’t anybody’s favorite party favor. But you may find yourself wondering if it’s bad to take acetaminophen — more commonly known as Tylenol® or paracetamol — for a headache during or after a boozy evening.

Hepatologist Christina Lindenmeyer, MD, has the answers.

Is it safe to take Tylenol when drinking?

In most cases, taking a normal dose of acetaminophen during or after a night of drinking shouldn’t cause liver damage. A “normal” dose is up to 1,000 milligrams (mg) over a four-to-six-hour period and a total of no more than 4,000 mg in a day.

But if you combine regular, moderate alcohol use with repeated daily doses of acetaminophen, it can make your liver more susceptible to a condition called acetaminophen toxicity.

Here’s the thing: The bar for moderate alcohol use may be a bit lower than you’re imagining. According to the U.S. Centers for Disease Control and Prevention (CDC), your alcohol consumption qualifies as moderate if you consume no more than one drink a day for women and no more than two drinks a day for men. They define heavy drinking as imbibing eight or more drinks for women, or 15 or more drinks for men in the course of a week.

Generally speaking, if you’re going to drink at a party or other social event and you take a couple of doses of acetaminophen the next day for your hangover, you should be fine. But if you regularly engage in heavy drinking or binge drinking, you’re better off only using acetaminophen in rare instances — and avoiding daily doses greater than 2,000 mg.

How it can affect your liver

As it does for many medications, your body metabolizes acetaminophen in your liver. When you take the recommended dosage, your liver converts most of it into a benign substance that’s removed in your urine. Your body also converts a very small amount of that metabolized acetaminophen into a toxin that can be harmful to your liver. Luckily, our bodies produce a secondary substance, glutathione, that helps minimize the toxic effects.

If you take too much acetaminophen — or if your liver doesn’t have enough glutathione stored up — the toxic metabolite can accumulate in your body and damage your liver.

So, where does alcohol fit in this picture? Your liver cells also metabolize alcohol. In fact, both acetaminophen and alcohol use glutathione to temper their toxic effects.

“Over time, chronic, heavy alcohol intake depletes your liver of its glutathione stores, which can lead to problems when acetaminophen is added to the mix,” Dr. Lindenmeyer shares.

Possible side effects of mixing alcohol and acetaminophen

It’s easy to underestimate Tylenol because so many of us grow up with it in our homes. And it seems to pop up everywhere!

According to the American Liver Foundation, acetaminophen is an ingredient in over 600 different over-the-counter and prescription medications. That makes it the most common drug ingredient in America. It also goes a long way toward explaining why overdoses happen so often: Approximately half of them are accidental.

Acetaminophen may be familiar, but that doesn’t mean it doesn’t have side effects. In addition to the risk of liver toxicity, Tylenol can also cause a number of unpleasant side effects, including:

• Nausea and vomiting.
• Abdominal pain.
• Constipation or diarrhea.
• Indigestion (dyspepsia).
• Cough or shortness of breath (dyspnea).
• Dry mouth.
• Skin rash.

As you’ve probably noticed, alcohol use causes several of those symptoms, too. So, when you mix alcohol and acetaminophen, the potential side effects can become more severe. Examples include bleeding ulcers in your stomach or intestines and rapid heartbeat.

According to Dr. Lindenmeyer, the biggest risk you take when you combine alcohol and Tylenol is liver failure. According to a 2019 study in The Lancet, acetaminophen toxicity accounts for nearly half of the cases of acute liver failure in North America and about a fifth of the liver transplant cases in the U.S. It can also cause kidney failure and painful inflammation of the pancreas (pancreatitis). Left untreated, these complications can be deadly.

Signs of acetaminophen toxicity to look out for (in addition to the ones we’ve already mentioned) include:

• Pain on the upper right side of your abdomen under your ribs.
• Dark, bloody or infrequent pee.
• Skin and eyes that appear yellow (jaundice).
• Abdominal pain and swelling.
• Unusual bruising or bleeding.
• Loss of appetite.
• Confusion, fatigue or loss of consciousness.
• Blurry vision.
• Excessive sweating (diaphoresis).

If you think you’re experiencing acute acetaminophen toxicity, it’s important to act fast, even if you don’t feel particularly unwell. Call 911, go to the emergency room or call a poison control center.

Other guidelines for taking Tylenol when drinking alcohol

Learning how to drink responsibly is important. So is learning how to medicate responsibly! Here are some tips Dr. Lindenmeyer says can help minimize your risk of complications on the rare occasion that you may need to mix acetaminophen and alcohol.

• Consider your current health conditions. Not everybody can take Tylenol safely. If you have a history of liver disease, for example, it’s a bad idea. The same is true if you’re living with alcohol use disorder (AUD). If you have chronic health conditions and aren’t sure whether it’s wise to take Tylenol, Dr. Lindenmeyer advises that you hold off until you have a chance to check with your provider.
• Review your medications. Before you head out to that karaoke party, take a look at your daily medications — both prescription and nonprescription — to see if any already contain acetaminophen. If they do, leave the Tylenol at home. (Note: Some drug labels use abbreviations like APAP and AC. Also keep an eye out for abbreviations that only partially spell out the drug name, like acetaminop and acetam.) If you can’t figure out whether your medications contain acetaminophen, contact your pharmacist.
• Follow dosing instructions. We all occasionally treat rules like suggestions. DO NOT do that with the dosing instructions on your Tylenol. Those are real rules with real consequences. Acetaminophen isn’t intended for daily use or to treat chronic pain. If you’re reaching for it like clockwork, it’s time to talk to your healthcare provider about other pain management options.
• Wash it down with water. If you twist your ankle mid pub crawl, you may be tempted to dry swallow your acetaminophen. But Dr. Lindenmeyer warns that that’s a bad idea. Taking pills without water presents a choking hazard. It also raises your risk for a variety of other problems, from acid reflux to soft tissue damage. (And no, booze isn’t an acceptable substitute for eight fluid ounces of H2O!)
• Consider alternatives. If you’re concerned about acetaminophen toxicity, it may make more sense to take something else for your aching back or pounding headache. Nonsteroidal anti-inflammatory drugs (NSAIDs) relieve pain and are less dangerous to take while drinking. They are, however, harder on your stomach and kidneys, so talk to your provider about what to take if you have gastrointestinal or kidney issues.
• Track your consumption. If you’re going to be out for a while, keep track of what you drank and when you drank it. The more alcohol you consume, the more dangerous that acetaminophen chaser is. If you do end up having to pop a pill, make a note of that, too.
• Mind what (and when) you eat. Drinking on an empty stomach gets you drunk faster and raises your risk for complications. But it’s also true that taking Tylenol on an empty stomach can help it take effect faster. And, just to make things more complicated, certain foods actually make it harder to absorb acetaminophen. So, think carefully about what you eat when you’re out on the town. If you think you may need to take a Tylenol, try to avoid cruciferous veggies, carbohydrates and foods that are high in pectin, like jelly or gummy candies. They can make the medication less effective.

The bottom line

Acetaminophen is an old standby for a reason. It’s a great (and safe) option for relieving pain and cooling fevers when taken correctly. While it’s safer when you’re sober, it’s generally OK to take Tylenol after you’ve had a drink or two, max.

But overdoses and acetaminophen toxicity can happen, so follow dosing instructions to the letter and contact your provider if you have any questions about whether to take Tylenol, or how to do it safely.